MS-2014-01389_0001.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASM 68008
Building Permit Application (402) 426 -4191 - Phone
9 _ ��� (402) 426 -4195 - FAX
MS- 2014 -01389 °'Oise ° l Ot' www.blairnebraska.org
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07/1712014 MISC Residential July 17, 2014
LOCATIONOFIMPROVEMENT: 11534 Horizon Ln, Blair, NE 68008
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ARCHITECT:
rz GENERAL Donald Andersen & Family
OWNER: Rhoda M, Trustee Schjodt CONTRACTOR: 235 S 9th St
Blair, NE 68008
11534 Horizon Ln
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
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PROJECT NAME PERMIT EXPIRES 07/1612016
11534HorizonLn- 140717 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12131/2014
DESCRIPTION OF WORK
Roofing and gutters
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
VIA— MEN
1. No work will be started before a permit is ISSUED AND POSTED.
2. For commercial permits, a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Office for review.
3. Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic system.
4. The undersigned owner or agent understands and acknowledges this building permit application does not constitute issuance of
this building permit. It is further understood that construction covered by this permit application shall not be commenced until a
copy of a permit signed by the Building Inspector is issued.
5. The undersigned owner or agent agrees to perform the proposed work in accordance with the specifications set forth above and
in accordance with the codes /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with or without the intention o the undersigned or any alteration or change from this application without approval of the
Bu' di Official, shall constitute icient ground for the revocation of any permit issued which was based on the approval of this
icatiorr.
Date
Signature of Applicant
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